Research on cancer-related cognitive impairment: A National Institutes of Health (NIH) grant portfolio analysis (2017–2024).

Abstract

e24039 Background: Cancer-related cognitive impairment (CRCI) among cancer survivors impacts school, work, and psychosocial functioning. With increasing survival rates across pediatric and adult cancer populations, there is a growing need to understand and mitigate acute and long-term CRCI. Methods: We analyzed NIH-funded research focused on CRCI by querying the NIH iSearch database, identifying 640 grants, with 185 meeting inclusion criteria for direct assessment of cognition in the context of cancer. Data were extracted from the specific aims and methods. Grants were characterized by research focus (clinical, preclinical, both), cancer types, and treatment modalities. Preclinical studies were coded for model type and cognitive assessments used. Clinical studies were coded for trial design, inclusion criteria, cognitive outcomes, biomarkers, and focus on underserved populations. Results: Of the 185 grants, 66% were clinical studies, 31% were preclinical, and 3% involved both human and animal research. Overall, the most studied cancer types were breast (31%), central nervous system (CNS) (25%), and hematological (22%). Treatment modalities were dominated by chemotherapy (34%) and radiotherapy (23%), while immunobiological (8%) and hormonal (6%) therapies were less frequently studied. Among 128 clinical studies, 65% were observational, while 38% were interventional. Of 48 interventional studies, 73% focused on behavioral/complementary medicine, and 25% explored pharmacologic interventions. The majority of clinical studies measured cognitive decline with objective cognitive assessments (88%) and patient-reported outcomes (76%). Conclusions: This analysis identifies trends and gaps in NIH-funded CRCI research. There is a lack of both preclinical and clinical CRCI research in the context of many high-incidence cancers, such as prostate, lung, and colorectal cancer. Cognitive impacts of emerging immunotherapy and hormonal therapies remain underexplored. The widespread use of both objective cognitive assessments and patient-reported outcomes reflects a comprehensive approach to understanding CRCI, but further focus on mechanistic-based interventions targeting CRCI is essential to improving patient quality of life.